After President Trump’s joint-address to Congress—at which he gave a rough outline of a replacement for Obamacare—Trump told reporters, “Nobody knew health care could be so complicated.” FiveThirtyEight’s Ben Casselman dryly noted that Trump’s remark drew “incredulous reactions from the approximately 100 percent of people who knew that health care could be so complicated.”
Due to the scope of health care reform, saying it’s complicated is an understatement. Consider this: Obama’s greatest legacy, the Affordable Care Act (ACA), is 2,700 pages long. The ACA is also accompanied by a series of about 20,000 pages of rules, regulations, and proposed regulations regarding the implementation of the law.
In addition to being highly complicated, health care reform has historically been politically risky. Many presidential plans for reform have stalled in Congress. Despite holding a series of 33 public rallies in support of the King-Anderson bill, President Kennedy’s health care reform plan was defeated in committee. President Nixon’s 1971 National Health Insurance Standard Act did not pass either. Bill Clinton’s American Health Security Act of 1993 came under bitter partisan scrutiny in Congress and failed in Sept. 1994.
Reforms that were passed, such as Obamacare, expended a massive amount of political capital and hurt presidential approval ratings.
If President Trump and the Republican Congress manage to pass comprehensive health care reform, it will likely hurt his public support, like it did to Clinton and Obama. However, in a much more likely scenario, Trump’s health care proposals will stall or fail in Congress altogether. Why is this likely?
The joint health care proposal endorsed by House Republicans on Monday drew criticism from many wings of the Republican Party, even after Trump endorsed the plan. Conservative organizations such as the Heritage Foundation promptly dubbed the American Health Care Act as “ObamacareLite.” One member of the House Freedom Caucs—Rep. Jim Jordan from Ohio—warned that “many Americans seeking health insurance on the individual market will notice no significant difference between the Affordable Care Act and the American Health Care Act.” However, it’s not just conservative House members who are unhappy with the plan. The Republican’s AHCA plan faces criticism from moderate Republican senators Lisa Murkowski, Cory Gardner, Shelley Moore Capito, and Rob Portman, all of whom signed on to a letter opposing the proposal.
Congress is receiving little guidance from Trump, who constantly contradicts himself on health care policy. During his campaign, Trump promised his supporters that that he does not want anybody to lose their health care. However, the plan Trump endorsed in his address would cause people with pre-existing conditions to pay significantly more for insurance, meaning that fewer people with conditions like diabetes and cancer would be able to purchase plans.
Ultimately, Republicans are struggling to find a solution that will garner support from both Congressional Republican hardliners like the House Freedom Caucus and from moderate Senators who represent swing states, such as Maine’s Susan Collins. Without strong guidance from the executive branch, passing a health care law to replace the ACA will likely prove impossible.